Public health

On 11 March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. COVID-19 remains the most widespread public health crisis in more than a century. By the end of 2021, more than 5.4 million COVID-19 deaths had been officially reported worldwide, although WHO estimates that the true death toll was substantially higher.

Unprecedented scientific, industrial, and political collaboration saw COVID-19 vaccines developed in record time. The vaccines were highly effective at preventing severe disease and protecting lives.

But by the end of 2021, just 33% of people in Africa had received a first dose and 98 countries had missed the target set by WHO of vaccinating 40% of their populations.

Market situation

COVID-19 vaccine distribution was fraught with inequality. While high-income countries quickly secured deals for billions of doses, lower-resource countries struggled to access the shots.

COVAX is a global partnership set up to ensure equitable access to COVID-19 vaccines. The COVAX Advance Market Commitment (AMC) pooled donor funding to enable 92 of the world’s lowest-income countries to receive COVID-19 vaccine free of charge. COVAX aimed to supply these doses as soon as possible.

As supply projections improved in mid-2021, COVAX announced a new Cost-Sharing Mechanism to enable AMC countries to self-finance additional doses. This would help countries to meet national vaccination targets and help them get back on track towards the WHO’s 40% target.

Public health

On 11 March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. COVID-19 remains the most widespread public health crisis in more than a century. By the end of 2021, it had claimed more than 14.9 million excess deaths, either directly or indirectly.

COVID-19 spread quickly around the world, leading to lockdowns and restrictions on movement. This made it even more difficult for people in low- and middle-income countries to access vital health products for conditions like HIV, malaria and tuberculosis. As a result, all three diseases saw increased case numbers and deaths.

The pandemic also took its toll on vaccination programmes. Gavi, the Vaccine Alliance reported that basic vaccine coverage fell by 1% in 2021, following a 4% drop in 2020.

Market situation

During the initial phase of the COVID-19 pandemic, demand outstripped supply for even the most basic medical products, leaving many countries struggling to provide vital equipment to frontline workers.

This situation was most acute in low- and middle-income countries (LMICs). Restricted supply, export bans and volatile prices meant that many countries were unable to access COVID-19 supplies. Countries were being quoted prices for some items of up to 20 times what they were pre-pandemic.

UNICEF is the world’s largest procurement agent of essential supplies on behalf of LMICs, country programmes and development partners. It has played a leading role in helping ensure access to products to tackle COVID-19 on top of its regular work procuring vaccines and other items on behalf of countries.

Public health

HIV causes AIDS, which is one of the leading causes of death by infectious disease. HIV transmission can be reduced if patients start taking combinations of medicines – called antiretroviral therapy (ART) – soon after acquiring HIV. Effective ART regimens can suppress HIV viral load, which can prevent death and onward transmission and allow patients to live longer, healthier lives.

In 2014, UNAIDS launched the “90-90-90” targets, calling for 90% of people living with HIV to know their status, 90% of those diagnosed to receive treatment, and 90% of those on treatment to achieve viral suppression by 2020. Those targets were later updated to “95-95-95” by 2030. However, in 2017, the year before the MedAccess agreement, only 81% of people receiving antiretroviral therapy were virally suppressed, and millions of people with HIV lacked access to viral load testing.

Market situation

Hologic’s Panther^® platform can test for HIV and viral hepatitis viral load and provide diagnosis for COVID-19 and human papillomavirus (HPV), the leading cause of cervical cancer. The Panther^® platform obtained World Health Organization (WHO) pre-qualification in December 2017.

The total size of the viral load market was around $190 million a year. At the time, the two dominant suppliers in Africa offered HIV viral load testing at a wide range of prices. Procurement of products and services was fragmented, leading to untransparent pricing. As a result, access to regular viral load testing was often limited in sub-Saharan Africa. Countries that had purchased viral load testing equipment had many machines out of use due to inconsistent service and maintenance.

Lives changed

Impact was based on estimates of the total reach of guaranteed tests and the depth of impact on patients by those tests. The depth factor was derived from the proportion of people receiving a viral load test that will switch to second-line antiretroviral therapy and the HIV-related mortality and disability burdens in Africa.

Money saved

Impact was estimated based on actual price reductions achieved throughout the course of the volume guarantee.

Markets shaped

We work with partners, including donors, procurers and ministries of health, to track changes in health markets where our investments are supporting access to products. We monitor for changes to policy, procurement practices and supplier movement, all of which affect markets and contribute to the long-term sustainability of our investments. To quantify change against a baseline, we used publicly available indicators as proxies for market-wide change.